What is CHC funding?
NHS continuing healthcare provides comprehensive support for adults with ongoing complex physical or mental health needs as a result of disability, injury or illness.
It is fully funded by the NHS and free of charge to the person receiving care. It is important to note that eligibility for NHS continuing healthcare is not based on an individual's wealth or any financial settlement they may have received related to future care costs.
This type of care can be provided in various settings outside hospital, including in your own home, or in a care home. The NHS will either provide services direct or a payment to cover the cost of the services required to meet your care needs.
Everyone who is eligible for NHS continuing healthcare has a right to request a direct payment to cover the cost of their care so that they can secure their own care services.
The assessment process
To be eligible for NHS CHC, you must be assessed by a team of healthcare professionals and the assessment process is lengthy and complex. Those who are eligible tend to be people with a very high level of healthcare needs requiring ongoing support and assistance.
For most people, there’s an initial checklist assessment which is used to decide if you need a full assessment. This checklist is usually completed by a nurse, social worker, or other qualified professional who assesses the individual's needs. However, if you need care urgently – for example, you’re terminally ill – your assessment may be fast-tracked.
Depending on the outcome of the checklist, you'll either be told you do not meet the criteria for a full assessment and are therefore not eligible, or you'll be referred for a full assessment of eligibility.
If you are assessed as a possible candidate, you will be referred to your local NHS Clinical Commissioning Group (CCG) for full assessment by a multi-disciplinary team (MDT) made up of at least two professionals from different healthcare professions. The MDT should usually include both health and social care professionals who are already involved in your care.
The assessment for NHS CHC involves evaluating various care needs and assigning them a weighting marked as "priority," "severe," "high," "moderate," "low," or "no needs."
Generally, if you have at least one "priority" need or "severe" needs in at least two areas, you can typically expect to be eligible for NHS continuing healthcare.
Additionally, you may also be eligible if you have a "severe" need in one area along with several other needs, or a combination of "high" or "moderate" needs, depending on their nature, intensity, complexity, or unpredictability.
Throughout the assessment process, the overall level of need and interactions between different needs will be carefully considered. Evidence from risk assessments will also play a role in determining whether you should receive NHS CHC.
Your input and the views of any carers you may have should be considered during the assessment. Moreover, you have the right to receive a copy of the decision documents, along with clear reasons for the decision.
Seeking professional advice regarding the assessment process is highly advisable. This will ensure all assessments are conducted correctly, and your case is presented clearly, demonstrating the impact of your care needs on your daily life.
How members of The Association of Lifetime Lawyers can help you
Our specialist Lifetime Lawyers are here to assist you through the entire process. They can help gather the necessary evidence to present your case effectively, attend meetings to ensure the completion of the assessment is accurate, challenge decisions you disagree with, and act as a liaison on your behalf.
If your application for NHS continuing healthcare is successful, our members can guide you through the implementation process and provide guidance on financial matters.
Please don't hesitate to contact one of our experienced Lifetime Lawyers for expert support tailored to your specific needs. You can find your local Lifetime Lawyer by visiting our find a lawyer page.